Have you ever had one of those moments when you laugh or exercise and have an “oops” moment? One of the main signs of stress incontinence is if you pee suddenly and uncontrollably, usually a small amount, during physical exertion. Sexual activity can also cause stress incontinence, which can be both embarrassing and upsetting.
The main types of incontinence are stress incontinence, urge incontinence, and mixed incontinence. Stress incontinence differs from urge incontinence which causes a sudden urge to pee and a loss of bladder control if you don’t get to the toilet in time. You will usually pass more urine when you have urge incontinence.
Many women will have symptoms of stress and urge incontinence, which is called mixed incontinence. Stress incontinence is considered a relatively common condition, and most women will experience symptoms of stress incontinence at some point in their lives.
5 Common Causes of Stress Incontinence
Stress incontinence is more common in women than in men. The five most common causes for women are:
- childbirth with vaginal deliveries
- chronic cough
- pelvic surgery
Although the symptoms vary, the most common symptom of stress incontinence is when you urinate involuntarily when your bladder is under pressure. Usually, this will only be a small volume of urine, but not always.
To help your doctor diagnose what type of incontinence you have, it is worth keeping a ‘bladder diary’ for a week. Write down every time you are unable to control your bladder and what you were doing at the time. You should also write down what you eat and drink to see if there are any triggers that cause your symptoms to become more frequent.
Managing Stress Incontinence
While looking into treatments for stress incontinence, you may find it makes life more comfortable if you use bladder protection pads. Additionally, there are several other things you can do which may help reduce the occurrence of stress incontinence, including:
- lose weight (if you are overweight)
- reduce caffeine intake
- limit alcohol use
- drink plenty of water
- eating a high fibre diet
- avoid straining if you have constipation
Treatments For Stress Incontinence
Before trying (or increasing) pelvic floor exercise or any other form of treatment for stress incontinence, you should first consult with your doctor. Your doctor can request imaging and rule out any underlying medical causes to ensure you receive the most effective treatment. The various ways stress incontinence is treated include:
- Pelvic Floor Exercises
It is crucial to make sure you are doing pelvic floor exercises correctly. The easiest way to locate your pelvic floor muscles is to imagine you need to stop yourself from having a pee. Sit on a flat surface and when you squeeze, make sure you are not clenching your bottom or thighs. Some women find using an app makes it easier to remember to do their pelvic floor exercises. Kegels and pelvic floor exercises can also be helpful, although they are not needed to perform effective pelvic floor exercises.
If you are struggling, the NHS has a handy pelvic floor exercise video on YouTube that shows you exactly how to do pelvic floor exercises. Speak with your doctor if you need extra support. You can also ask to be referred to an NHS pelvic health clinic, where you can work with midwives, specialist doctors and specialist physiotherapists.
- Vaginal Pessaries
Pessaries are made to sit inside your vagina to treat stress incontinence. They can also be used to help diagnose if an anatomic defect or bladder instability could be the cause of stress incontinence. The most common pessary supplied initially for incontinence treatment is a ring pessary. This is flexible and easy to take in and out for sexual intercourse. Some women can not use a ring pessary if they have very weak pelvic floor muscles. Your doctor will be able to advise you on other options if this is the case.
Stress incontinence can not be treated with the same medications used for urge incontinence. There is only one medication, duloxetine, that the NHS currently prescribes for stress incontinence. You might need to give the drug two to four weeks before you can tell if it is having any effect. As with all medications, duloxetine can cause side effects, such as nausea, fatigue, constipation, and dry mouth.
- Non-Surgical Treatment
A non-surgical treatment that may be offered if other methods to reduce stress incontinence have not been successful is an injection of a bulking agent.
This treatment is typically recommended if you think you may want to get pregnant. It involves injecting a synthetic bulking agent into the urethra and is generally performed under local anaesthetic, though some women opt for a spinal block or general anaesthetic. Most women do not need to stay in hospital overnight and can return to normal daily activities within a couple of days of treatment.
A second treatment may be required after four to six weeks and limited research indicates that the results are likely to wear off within a few years. However, you can opt to have the procedure repeated if that is the case.
The most common method of surgery for stress incontinence is colposuspension. This is performed under general anaesthetic and involves lifting tissue using stitches at the neck of the bladder. Colposuspension can be performed via keyhole surgery (laparoscopic surgery) or open surgery through small incisions in the lower abdomen. Normally you will remain in hospital for one to two nights and will need around six weeks to recover after a colposuspension.
Alternative Non-Invasive Treatment For Stress Incontinence
The most recent advancement for non-invasive treatment for stress incontinence is called the Emsella treatment, developed by medical and aesthetics manufacturer BTL, award winner for Innovation in Women’s Health. With no need to get undressed, this treatment takes less than 30 minutes per session and is totally painless.
During treatment, you simply sit in the Emsella chair while it works your pelvic floor utilising high-intensity focused electromagnetic (HIFEM) technology to create the equivalent of thousands of supramaximal pelvic floor muscle contractions.
Additionally, unlike traditional pelvic floor exercises, the technology strengthens the entire pelvic floor. Although there is limited research, current scientific studies show promising results and 95% positive patient feedback.
We spoke with Louise White, a leading women’s health expert and director of Body Lipo Lincoln, one of the first clinics to offer the Emsella treatment.
“As a medically led clinic offering treatments that have been scientifically developed and tested is really important to me. When I found out about the Emsella Chair I had to try it myself. After just six sessions my stress incontinence was no more. Only then did I purchase an Emsella Chair for my clinic, for the treatment of urinary incontinence.”
The Emsella Treatment for Urinary Incontinence
Currently, the NHS does not provide the Emsella treatment, which means you will have to go to a private clinic. A course of six treatments is recommended for the best results. If symptoms do return, you can simply have a top-up treatment. Top-up treatments are only required by some women every six to 12 months.
After six sessions, many women find that they are ‘cured’ of stress incontinence. Other types of incontinence can also be treated with the Emsella chair. When looking for a clinic, check if they are medically led and how long they have provided the Emsella treatment. Ideally, choose a clinic with a women’s health expert on the team.
*This article is not intended to replace medical advice, diagnosis or treatment given by a qualified health professional. Instead, this article only provides information, not advice. For any medical enquiries, always consult your GP, midwife, postpartum nurse or specialist health professional first*